In rural Kentucky, health-care debate takes back seat as the long-uninsured line up

[mota bhai 2,675]

By Stephanie McCrummen, Published: November 23

in BREATHITT COUNTY, Ky.

... in a state where the rollout has gone smoothly, and in a county that is one of the poorest and unhealthiest in the country, Courtney Lively has been busy signing people up: cashiers from the IGA grocery, clerks from the dollar store, workers from the lock factory, call-center agents, laid-off coal miners, KFC cooks, Chinese green-card holders in town to teach Appalachian students.

Now it was the beginning of another day, and a man Lively would list as Client 375 sat across from her in her office at a health clinic next to a Hardee’s.

“So, is that Breathitt County?” she asked Woodrow Wilson Noble as she tapped his information into a laptop Thursday morning.

“Yeah, we live on this side of the hill,” said Noble, whose family farm had gone under, who lived on food stamps and what his mother could spare, and who was about to hear whether he would have health insurance for the first time in his 60-year-old life.

This is how things are going in Kentucky: As conservatives argued that the new health-care law will wreck the economy, as liberals argued it will save billions, as many Americans raged at losing old health plans and some analysts warned that a disproportionate influx of the sick and the poor could wreck the new health-care model, Lively was telling Noble something he did not expect to hear.

“All right,” she said. “We’ve got you eligible for Medicaid.”

Places such as Breathitt County, in the Appalachian foothills of eastern Kentucky, are driving the state’s relatively high enrollment figures, which are helping to drive national enrollment figures as the federal health exchange has floundered. In a state where 15 percent of the population, about 640,000 people, are uninsured, 56,422 have signed up for new health-care coverage, with 45,622 of them enrolled in Medicaid and the rest in private health plans, according to figures released by the governor’s office Friday.

If the health-care law is having a troubled rollout across the country, Kentucky — and Breathitt County in particular — shows what can happen in a place where things are working as the law’s supporters envisioned.

One reason is that the state set up its own health-insurance exchange, sidestepping the troubled federal one. Also, Gov. Steve Beshear (D) is the only Southern governor to sign on to expanded eligibility parameters for Medicaid, the federal health-insurance program for the poor. The less technical reasons involve what Lively told Noble next.

“Okay, Woodrow, now you get to shop a little bit,” she said, explaining options he’d never had before.

“If you go to the doctor, all you’re going to pay is $1,” she began. “If you’re in the hospital for an extended period, you should only be billed $5. . . . If you get medicine, generics are $1 and brand is $4. . . . You can go to the dentist once a month — exams, X-rays and cleanings are covered. . . . Now for your teeth, the plan does take care of having them pulled and does take care of fillings, but not bridges, because that’s considered cosmetic.”

Now, Lively explained, Noble simply had to choose among several Medicaid health-care plans. “So basically it’s whatever insurance company you go with — the effective date is January 1st,” she said, waiting for him to pick.

“My mom gets that WellCare, and she don’t pay nothing,” Noble said finally. “I’ll take that WellCare plan. My mommy got that, and it’s good.”

“WellCare it is,” Lively said, typing in his decision as Noble considered Jan. 1.

“I got some warts on me I got to take off, some moles,” he said. “I might have that colonoscopy done. My mom had colon cancer twice. I never had money to do it.” He said he was told it could cost at least $2,000.

“I got this pain in my left shoulder,” he said, lifting his arm and rotating it. “Might be arthritis, I guess. I don’t know.”

Lively handed Noble some papers confirming his enrollment.

“Okay, you’re good to go — you tell your brother to come see me,” she said, and the next client walked in.

Lively grew up in the county and works for Juniper Health, which has a federal contract to enroll people in the state health-care exchange and runs the Breathitt County health clinic on Highway 15, a four-lane that branches off into narrow roads that wind through hills dotted with skinny trees and trailers.

Asked to describe Breathitt, Lively paused for a moment. “Poor,” she said. “Just poor.”

The per-capita income in Breathitt is about $15,000, and the rates of diabetes, hypertension and other health problems earned this part of Kentucky the nickname “Coronary Valley.”

Lively, who has been signing people up since the exchanges opened in early October, said one woman cried when she was told she qualified for Medicaid under the new law. She said people have been “pouring in” to her office, an unused exam room in the back of the clinic, where her set-up includes a table, a two-drawer filing cabinet, manila folders, a planner to track her schedule, a notebook to track her numbers and a laptop that connects to the state health-insurance exchange, Kynect.

Clinic doctors often send patients without insurance her way after their visits, but most come by word of mouth. Lively has signed up fathers who then sent their sons, and mothers who sent aunts. She signed up one Subway sandwich shop worker, and soon what seemed like the whole staff showed up.

Although she once had to dispel a rumor that enrolling involved planting a microchip in your arm, and though she avoids calling the new law “Obamacare” in a red state, most people need little persuading.

“All right,” she said to her next client, a 52-year-old disabled master electrician who said his mother, two brothers and two sisters all died from lung cancer. He had been ignoring a spot on his lung discovered during a visit to the emergency room after he had broken his ribs several years ago.

He also vaguely recalled being told at the time he had something called “wedging of the spine.”

“What do I need here?” said Jeff Fletcher, who was being sued for those medical bills. “Proof of income?”

“Yep,” Lively said, and Fletcher pulled out documents showing that he and his wife live on about $500 a month in food stamps and her disability check.

“You smoke?” Lively asked, going through a few routine questions.

“Right- and left-handed,” he quipped as she typed.

“All right,” Lively said after a while. “You are covered.”

“I’m covered?” Fletcher said. He slapped the table. He clapped twice.

“Woo-hoo! I can go to the doctor now?” he asked Lively. “I’m serious. I need to go.”

Client 377 sat in the chair next. Ruth Strong, a 45-year-old woman with red, streaklike marks on her right arm, shoulder and neck from an untreated allergy attack, chatted with Lively about their kids. Strong was saying she wanted both her boys to go to college.

“Now, how much did you say it was going to cost to add you on?” asked Lively, who had talked to Strong before about signing on to the health-insurance plan of her husband, who worked for the school district. “Four hundred dollars?”

“Yes,” Strong said, looking at the floor and smiling. “I guess I’ve been without it for 15 years and will go without it one more if it costs too much.”

Lively entered Strong’s information. Her household income was too high for Medicaid, but she qualified for a subsidy of $228 a month and could choose from plans with a monthly cost ranging from $115 to $300, Lively said.

“It’s still high,” said Strong, who had not had a checkup in nine years.

Lively handed her a description of the health plans to take home and study, and then it was time for lunch, which Lively ate in the office between returning calls:

“Brenda, this is Courtney Lively calling you back.”

“You want to set up an appointment?”

“I will be here 8 to 4 tomorrow.”

Soon, Ronald Hudson walked in.

“Okay,” Lively began. “What Hudsons are you kin to?”

“R.T., Uncle Lenny . . .” said Hudson, a skinny 35-year-old who worked as an assistant director at the senior center and had just been released from the hospital after a blood-sugar spike.

He’d never had insurance before and said his hospital bills were up to $23,000 at this point.

“Good night,” Lively said, tapping in his information.

Kids: five. Salary: about $14,000 before taxes.

“You’re going to qualify for a medical card,” she told Hudson.

“Well, thank God,” Hudson said, laughing. “I believe I’m going to be a Democrat.”

Lively printed out his papers.

“RONALD’s Health Care Coverage Options,” one of them read.

“Oh, man,” Hudson said.

Donna Robinson had already enrolled, and now she arrived for her 2 p.m. with her son Gary Gross, 36, a skinny man with spiky copper hair, worn-out jeans and a thin tank top.

“Now,” Lively began. “Any income?”

“Naw,” Gross said.

“You smoke?”

“Yeah,” Gross said, adding that he did quit drinking. “It’s hard to quit, I tell you. I got cirrhosis already. I’m only a two on the scale of four, not too bad.”

“That’s already bad,” his mother said.

“Okay,” Lively said after a while. “You’re covered for a medical card.”

She went through his options.

“Now, I have problems with my teeth,” Gross said. “I need to get all of them pulled.”

“It does cover that,” Lively said.

“Oh, that’s great!” Gross said, sitting up straighter.

“Now it doesn’t cover dentures,” Lively said as she typed.

“I think that should be covered,” his mother said. “Try to eat an apple without teeth.”

“I love meat,” Gross said.

Lively gave him the papers confirming his enrollment.

“Easy as that,” she said.

“Wow,” Gross said, looking at them. “Thank you.”

In was late afternoon, and Mary Stamper, 36, arrived with four of her 11 children and a stack of well-worn, laminated Social Security cards. She sat down.

“I don’t see how you do it 11 times, girlfriend,” Lively said as the children bounced around the room. “Okay, what’s Mark’s birthday?”

It took an hour to enter in all her kids’ information and tally the household income from food stamps and a disability check drawn by her husband, a county maintenance worker.

Stamper said that she had Medicaid once when she was pregnant with one of her first children but that otherwise the part-time jobs she had held at the check-cashing place and as a nurse’s aide never came with it.

Lively typed her information in, and then something unusual happened: The system seemed to crash. She called the help line for the state health-care exchange and was told it was just being updated.

“I can tell you you’re getting a medical card,” she told Stamper, knowing what would happen when the system came back. “You’re going to get approved — I have no doubt about that. . . . You want WellCare?”

“Yeah,” Stamper said.

She stood up and stretched her back, which had been bothering her.

“I’m relieved,” she said. “I’ve been worried.”

Stamper and her kids left. It was the end of a long day, and Lively took a moment to look over her schedule for Friday. She had three appointments written in her planner and six calls to return.

“I’m nonstop,” she said.

http://www.washingtonpost.com/national/in-rural-kentucky-health-care-debate-takes-back-seat-as-people-sign-up-for-insurance/2013/11/23/449dc6e0-5465-11e3-9e2c-e1d01116fd98_story.html

[lostinblue 1,989]

The kenyan's war on coal forced the majority of the population in the county to be on welfare. Now he can save them with kenyan kare because they cannot afford to pay for a doctor.This county was hit hard by the loss of coal mining jobs

[Mr. Big Dog 10,747]

The kenyan's war on coal forced the majority of the population in the county to be on welfare. Now he can save them with kenyan kare because they cannot afford to pay for a doctor.This county was hit hard by the loss of coal mining jobs

2000: The median income for a household in the county was $19,155, and the median income for a family was $23,721. Males had a median income of $26,208 versus $20,613 for females. The per capita income for the county was $11,044. About 28.10% of families and 33.20% of the population were below the poverty line, including 42.90% of those under age 18 and 26.80% of those age 65 or over.

Per capita money income in the past 12 months (2011 dollars), 2007-2011 $15,048 Median household income, 2007-2011 $22,304 Persons below poverty level, percent, 2007-2011 30.0%

$15,048 > $11,044 - i.e. per capita income is up

$22,304 > $19,155 - i.e. median household income is up

30% < 33.2% - i.e. poverty is down

You fail. Again.

[Neonred 3,654]

There is certainly great concern how Kentucky will fund this additional demand.

[Peikko 1,575]

Of course funding Affordable Health care is and should be a concern. Now, seeing as this story has been highlighted, what in your opinion should have happened? Should the US just have carried on down the same path it had been going with hard working but extremely poor people being 'out of luck' when it came to health care? Would you like to go talk to these people having glimpsed some light at the end of their tunnel and say sorry old bean, we didn't really mean it, you can't go to the Doctor after all? The negativity is ridiculous. The solution that has been implemented may be flawed, it may need updating and it may need tweaking but simply saying it's #######, go start again is basically condemning these, and people like them to a third world life style in a first world country. Is that what you think is right for your fellow Americans?

[Darnell 8,479]

Kentucky Navigators FTW ! Yay !

[Merle 458]

For everyone that doesn't feel like reading that long first post I'll summarize it in this post: The government starts handing out (perceived) freebies and people show up in droves to receive them. The End.

[mota bhai 2,675]

For everyone that doesn't feel like reading that long first post I'll summarize it in this post: The government starts handing out (perceived) freebies and people show up in droves to receive them. The End.

I have to wonder at what point in our history did American conservatism become so downright sociopathic?

[GandD 5,966]

Two things that stick out. The guy that doesn't work and is a recovering alcoholic and the woman with 11 kids. These are most likely leaches and will never do anything other than take. BUT, the other folks mentioned here are exactly what the bill and compassionate humans are looking to address. People that have little to no chance at making a decent living where they live and have no options for healthcare. So yes, sometimes worthless people benefit from your tax money in order to help others in the same socio-economic class that are actually trying. It is better than the alternative of screwing over the people that are trying because you might accidentally help the ones that aren't.

[Harpa Timsah 13,258]

It's possible that the lady with 11 kids, has she been given access to healthcare, birth control, and some education at the doctor, might have decided to have less than 11 kids.

[GandD 5,966]

I suppose that is possible. But I'm a little skeptical after 10.

[mota bhai 2,675]

Don't hate on her cuz she's fertile, damn.

[Peikko 1,575]

The deserving poor argument. There are two reasons why it should be avoided. The first is simple economics. If you want to help people who are in poverty, the simplest system is to help people based on financial indicators. You make an assessment on what constitutes the poverty line and you assist those who fall below it. It's simple to administer (that means it's cheap to administer) and most of the time it does assist those who you may feel are 'deserving' even though in the process those who may not be 'so deserving' will also be assisted.

The second is that 'deserving' is necessarily subjective. Once you reject the idea that if you fall below a certain lever of income you are necessarily in need of assistance deciding who 'deserves' assistance and who does not becomes a complicated and subjective assessment.. Who decides that a woman who has 11 children is necessarily undeserving? Is she undeserving because you think she's a fool? If she's a fool surely she becomes more deserving as she can't help herself, she is a victim of her inability to behave in a way that is rational and logical. Until and unless we decide to go down the 'sterlise the poor' route that's not something that is really in the purview of the government. The best that can be hoped for is that she seeks assistance and gets help to make better decisions, not punish her for something we already know she isn't very good at.